Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder—It’s sex specific

doi:10.1016/j.ridd.2018.07.010

Research in Developmental Disabilities

Volume 84, January 2019, Pages 57-65

https://doi.org/10.1016/j.ridd.2018.07.010 Get rights and content

Highlights

•
Bone health differences vary between boys and girls with LMC/DCD.
•
Boys with LMC/DCD had less robust bones than healthy age-matched Australian boys.
•
Girls with LMC/DCD had similar bone health to healthy age-matched Australian girls.

Abstract

Background

Australian adolescents with low motor competence (LMC) have higher fracture rates and poorer bone health compared to European normative data, but currently no normative data exists for Australians.

Aims

To examine whether there were bone health differences in Australian adolescents with LMC or Developmental Coordination Disorder (DCD) when compared to typically developing age-matched Australian adolescents.

Methods and Procedures

Australian adolescents aged 12–18 years with LMC/DCD (n = 39; male = 27; female = 12) and an Australian comparison sample (n = 188; boys = 101; girls = 87) undertook radial and tibial peripheral Quantitative Computed Tomography (pQCT) scans. Stress Strain Index (SSI (mm³)), Total Bone Area (TBA (mm²)), Muscle Density (MuD [mgcm³]), Muscle Area (MuA [cm²]), Subcutaneous Fat Area (ScFA [cm²]), Cortical Density (CoD [mgcm³]), Cortical Area (CoD [mm²]), cortical concentric ring volumetric densities, Functional Muscle Bone Unit Index (FMBU: (SSI/bone length)) and Robustness Index (SSI/bone length^3), group and sex differences were examined.

Outcome and Results

The main finding was a significant sex-x-group interaction for Tibial FMBU (p = .021), Radial MuD (p = .036), and radial ScFA (p = .002). Boys with LMC/DCD had lower tibial FMBU scores, radial MuD and higher ScFA than the typically developing age-matched sample.

Conclusion and Implications

Comparisons of bone measures with Australian comparative data are similar to European findings however sex differences were found in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to their well-coordinated Australian peers, whereas there were no differences between groups for girls. These differences may be due to lower levels of habitual weight–bearing physical activity, which may be more distinct in adolescent boys with LMC/DCD compared to girls.

Section snippets

What this paper adds?

Little is known about the bone health of adolescents with LMC/DCD. Previously the authors have shown that bone health deficits are present when compared to European normative data. This study further explored these bone health differences in the Australian context, comparing Australian adolescents with LMC/DCD to typically developing age-matched Australian adolescents. The results revealed Australian adolescent boys with LMC/DCD had less robust bones compared to non-affected Australian peers,

Materials and methods

This study conducted a re-analysis of a published dataset from AMPitup (Hands et al., 2015) (described below) which used previously standardised bone data to the reference database (Moyer-Mileur, Quick, & Murray, 2008; Neu, Manz, Rauch, Merkel, & Schoenau, 2001) and included any new participants enrolled during 2015-2017. This study examines the raw bone data prior to standardization (as per 2.4 below). The typically developing cohort was drawn from data from the Griffith University Bone

Results

Participants with LMC/DCD were on average one year younger (14.4 ± 1.3 years) than the comparison group (15.3 ± 1.8 years) (p = .007), although this was not statistically significant when analysed according to sex (boys: p = .102; girls: p = .096), with both equally represented for the radius (54.1% male, 43.9% female) and tibia measures (53.2% male, 46.8% female). There were no significant differences between the LMC/DCD group and comparison group for tibial bone length (p = .446) and forearm

Discussion

The aim of the current study was to examine whether there were bone health differences in Australian adolescents with LMC/DCD when compared to typically developing age-matched Australian adolescents using pQCT data. Differences in bone parameters between Australian adolescents with LMC/DCD versus typically developing age-matched Australian adolescents described in this paper were similar to European normed between-group comparisons (Hands et al., 2015). New analyses based on sex revealed that

Conclusions

Comparisons of bone measures from adolescents with LMC/DCD with Australian comparative data are similar to European norm results revealing poorer bone health outcomes. However sex differences were found between boys and girls with LMC/DCD in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to Australian comparative data, whereas there were no between-group differences for girls. The mechanism which may explain these differences is not understood, but may

Funding

This work was supported by the Australian Government’s Collaborative Research Network (CRN) program and the WA Department of Health FutureHealth WA First Year Initiatives – Mentoring Grant 2016. The AMPitup program was in part supported by a generous grant of the Princess Margaret Hospital Foundation. The funders had no involvement in study design; data collection, analysis and interpretation; writing of the report; or the decision to submit the article for publication.

Declaration of interest

The authors declare no actual or potential conflict of interest including any financial, personal or other relationships with other people or organisations within three years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work.

Acknowledgements

We are grateful to the AMPitup adolescents and their families who took part in this study and Carlos Bervenotti and Tanya Blee from The University of Notre Dame Fremantle. Thanks extend to the staff of the Department of Diagnostic Imaging at Princess Margaret Hospital for their expertise and support of the project, in particular Brendan Beeson, Drew Williams and Fiona Bettenay.

References (45)

M. Cantell et al.
Physical fitness and health indices in children, adolescents and adults with high or low motor competence
Human Movement Science
(2008)
M. Doube et al.
BoneJ: Free and extensible bone image analysis in ImageJ
Bone
(2010)
S.L. Francis et al.
Sustained effects of physical activity on bone health: Iowa Bone Development Study
Bone
(2014)
D. Green et al.
The risk of reduced physical activity in children with probable Developmental Coordination Disorder: A prospective longitudinal study
Research in Developmental Disabilities
(2011)
B. Hands et al.
The psychometric properties of the McCarron Assessment of Neuromuscular Development as a longitudinal measure with Australian youth
Human Movement Science
(2013)
L.J. Moyer-Mileur et al.
Peripheral quantitative computed tomography of the tibia: Pediatric reference values
Journal of Clinical Densitometry
(2008)
C.M. Neu et al.
Bone densities and bone size at the distal radius in healthy children and adolescents: a study using peripheral quantitative computed tomography
Bone
(2001)
R.C. Nogueira et al.
An in-school exercise intervention to enhance bone and reduce fat in girls: The CAPO Kids trial
Bone
(2014)
T. Rantalainen et al.
Effects of bone-specific physical activity, gender and maturity on tibial cross-sectional bone material distribution: A cross-sectional pQCT comparison of children and young adults aged 5-29years
Bone
(2015)
T. Rantalainen et al.
Long bone robustness during growth: A cross-sectional pQCT examination of children and young adults aged 5–29 years
Bone
(2016)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders (DSM-5)

(2013)

G.I. Baroncelli et al.

(2005)

M.L. Bianchi et al.

Official positions of the International Society for Clinical Densitometry (ISCD) on DXA evaluation in children and adolescents

Pediatric Nephrology

(2010)

J.P. Bonjour et al.

Pubertal timing, bone acquisition, and risk of fracture throughout life

Endocrine Reviews

(2014)

K. Deere et al.

A cross-sectional study of the relationship between cortical bone and high-impact activity in young adult males and females

The Journal of Clinical Endocrinology and Metabolism

(2012)

K. Deere et al.

Habitual levels of high, but not moderate or low, impact activity are positively related to hip BMD and geometry: Results from a population-based study of adolescents

Journal of Bone and Mineral Research

(2012)

R.K. Dishman et al.

The determinants of physical activity and exercise

Public Health Reports

(1985)

J.N. Farr

Associations of physical activity duration, frequency, and load with volumetric BMD, geometry, and bone strength in young girls

Osteoporosis International

(2011)

A. Fonseca et al.

Peripheral quantitative computed tomography (pQCT) to assess bone health in children, adolescents, and young adults: A review of normative data

Journal of Pediatric Hematology Oncology

(2013)

J. Fritz et al.

Influence of a school-based physical activity intervention on cortical bone mass distribution: A 7-year intervention study

Calcified Tissue International

(2016)

R.K. Fuchs et al.

Jumping improves hip and lumbar spine bone mass in prepubescent children: A randomized controlled trial

Journal of Bone and Mineral Research

(2001)

B. Hands et al.

Physical fitness differences in children with and without motor learning difficulties

European Journal of Special Needs Education

(2006)

Cited by (8)

Trajectories of osteogenic physical activity in children and adolescents: A 3-year cohort study
2024, Journal of Science and Medicine in Sport
We explored the latent profiles based on locomotor skills and cardiorespiratory fitness in Finnish schoolchildren and examined their associations with latent growth curves of osteogenic physical activity (PA) over three years.
Prospective cohort study.
Altogether 1147 Finnish adolescents aged 11–13 years participated in the study. Osteogenic PA in terms of osteogenic index (OI) was calculated based on acceleration peak histograms using all of the peaks with acceleration > 1.3 g. Locomotor skills were assessed using the five-leap and side-to-side jumping tests and cardiorespiratory fitness (CRF) using 20-metre shuttle run test. The latent growth curve models for the locomotor skills and cardiorespiratory fitness profiles were tested to examine the longitudinal development of OI scores over time three years (from T0 to T3).
OI scores were lower amongst children in the “Low locomotor profile” compared with “Moderate” and “High locomotor” profiles. The OI scores linearly decreased from T0 to T3 in each locomotor profile and the decrease was similar in all the profiles. Moreover, OI scores were lower in the “Low CRF profile” compared with “Moderate” and “High CRF” profiles. The OI scores decreased in each profile over time, but the decrease was steepest in the “Low CRF profile”, whereas “Moderate” and “High CRF profiles” had similar developmental trajectories.
Children with the highest locomotor skills and higher CRF accumulate more osteogenic PA than their least skilful and fit peers, which can have important implications on bone health in this critical period for bone growth.
Caregiver burden and mental health: Parent perspectives when raising a child with developmental coordination disorder
2024, Research in Developmental Disabilities
Children with Developmental Coordination Disorder (DCD) are at high risk for mental health disorders, stemming from challenges participating in motor activities. Parents of children with DCD report increased caregiver burden exacerbated by insufficient support and services for their child. A paucity of literature exists on parent and child mental health associated with a DCD diagnosis.
To explore parent perceptions of their child’s mental health, and the impact of DCD on family and parental mental health.
Implementation of a secondary analysis using the impACT for DCD, a cross-sectional online survey of parents of children with self-reported suspected or confirmed diagnosis of DCD living in British Columbia, Canada. Data analysis included descriptive and inferential statistics and content analysis.
Of the 237 participants, more than one third of parents (36%) rated their own mental health to be fair or poor, and the majority (90%) expressed concern for their child’s mental health. Themes emerged on the impact of DCD on child, parent, and family, influenced by access to resources.
Standard of care for DCD needs to include services and supports that address caregiver burden and mental health of children with DCD and their families.
This paper explores parent perceptions of their child(ren)'s and their own mental health when raising a child with DCD in British Columbia (BC). In BC, there is a lack of research on the mental health challenges families face when their child has a diagnosis of DCD. Amongst health care providers, there tends to be a focus on DCD as a motor disorder, with limited understanding and acknowledgement of the mental health component for children and their families. Thus, this study will inform health-care providers, parents, educators, and policy makers on parent-identified mental health needs and the essential services and supports. Unique to this study was the inclusion of a descriptive and exploratory content analysis, providing a holistic understanding of parents’ perceptions regarding the impact of DCD on their children and themselves. Our results revealed that parents perceive significant inter-connected impacts of DCD on the child, parents, and family, leading to poor mental health for parents and their child(ren). Limited access to resources and supports results in a negative trajectory for family mental health and well-being. Study results indicate the critical importance of addressing mental health, in addition to motor challenges. Healthcare providers need to adopt a family-centred approach to address the physical and psychosocial impairments associated with DCD, ensuring positive outcomes for children and their families.
Association of developmental coordination disorder and low motor competence with impaired bone health: A systematic review
2022, Research in Developmental Disabilities
Citation Excerpt :
Ten studies were excluded in this manner, details of which are in Appendix C. Two sets of papers and conference publications were considered as potentially from the same cohort based on author, population, and ethics details. The first set (Cohort 1) (Chivers et al., 2019; Hands et al., 2015; Jenkins et al., 2020; Tan et al., 2020) was known to be of the same study cohort as PC and JT were authors. For the other paediatric cohort (Cohort 2) (Fong et al., 2018; Ma et al., 2018; Yam & Fong, 2017) considered likely to be a shared cohort attempts to contact the author via email were unsuccessful, as the account was closed.
Individuals with developmental coordination disorder (DCD) and low motor competence (LMC) may be at increased risk of low bone health due to their lifetime physical activity patterns. Impaired bone health increases an individual’s risk of osteoporosis and fracture; therefore, it is necessary to determine whether a bone health detriment is present in this group. Accordingly, this systematic review explores the association between DCD/LMC and bone health.
Studies were included with assessment of bone health in a DCD/LMC population. Study bias was assessed using the JBI critical appraisal checklist. Due to heterogeneity, meta-analysis was not possible and narrative synthesis was performed with effect size and direction assessed via harvest plots.
A total of 16 (15 paediatric/adolescent) studies were included. Deficits in bone measures were reported for the DCD/LMC group and were more frequent in weight-bearing sites. Critical appraisal indicated very low confidence in the results, with issues relating to indirectness and imprecision relating to comorbidities.
Individuals with DCD or LMC are at increased risk of bone health deficits. Bone impairment locations indicate insufficient loading via physical activity as a potential cause of bone deficits. Results indicate a potential for earlier osteoporosis onset.
Biomechanics of immature human cortical bone: A systematic review
2022, Journal of the Mechanical Behavior of Biomedical Materials
Citation Excerpt :
Moyer-Mileur et al. (2008) determined the cortical area of the tibial diaphysis to range from 96.6 to 346.2 mm2 in children 5–18 years. The largest value reported in Moyer-Mileur et al. (2008) (346.2 mm2) is smaller than the largest value reported in Chivers et al. (2019) (418.9 mm2). Sládek et al. (2019) measured a cortical area of 79.9–159.7 mm2 in maturing tibiae, age 7–12 years.
The whole bone geometry, microstructure, and mechanical properties of mature human bone are widely reported; however, immature bone (0–18 years) has not been similarly robustly characterized. There is an interest in analyzing and predicting the mechanical loading conditions associated with long bone diaphyseal fractures attributed to trauma in children. Thus, understanding the mechanical properties of immature bone in a temporal reference frame is an essential first step to understand diaphyseal fractures of pediatric long bones. The purpose of this systematic review was to ask, what is the state of knowledge regarding the 1) evolution of whole bone geometry and microstructure of immature pediatric bone as a function of maturation and 2) cortical bone density and experimental quasi-static mechanical properties at the tissue level in the diaphyseal region of immature pediatric long bones? The systematic search yielded 36 studies of the whole bone geometry, microstructure, and mechanical properties of immature pediatric long bones. The elastic modulus, yield stress, and ultimate stress were shown to generally increase with maturation, whereas the yield strain was approximately invariant; however, the specific year-to-year progression of these properties could not be characterized from the limited studies available. The results of this systematic search indicate there is a dearth of knowledge associated with the biomechanics of cortical bone from immature pediatric long bones; it also provides a basis for computational studies of immature human long bones. Additional biomechanical studies of immature human bone are necessary to develop a robust catalogue, which can be used in broad applications to understand fracture mechanics, bone pathologies, and athletic injury in the pediatric setting.
Reduced Peak Bone Mass in Young Adults With Low Motor Competence
2023, Journal of Bone and Mineral Research
Association between developmental coordination disorder or low motor competence, and risk of impaired bone health across the lifespan: Protocol for a systematic review and meta-analysis
2021, JBI Evidence Synthesis

View all citing articles on Scopus

View full text

Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder—It’s sex specific

Highlights

Abstract

Background

Aims

Methods and Procedures

Outcome and Results

Conclusion and Implications

Section snippets

What this paper adds?

Materials and methods

Results

Discussion

Conclusions

Funding

Declaration of interest

Acknowledgements

Human Movement Science

Bone

Bone

Research in Developmental Disabilities

Human Movement Science

Journal of Clinical Densitometry

Bone

Bone

Bone

Bone

Diagnostic and statistical manual of mental disorders (DSM-5)

Official positions of the International Society for Clinical Densitometry (ISCD) on DXA evaluation in children and adolescents

Pediatric Nephrology

Pubertal timing, bone acquisition, and risk of fracture throughout life

Endocrine Reviews

A cross-sectional study of the relationship between cortical bone and high-impact activity in young adult males and females

The Journal of Clinical Endocrinology and Metabolism

Habitual levels of high, but not moderate or low, impact activity are positively related to hip BMD and geometry: Results from a population-based study of adolescents

Journal of Bone and Mineral Research

The determinants of physical activity and exercise

Public Health Reports

Associations of physical activity duration, frequency, and load with volumetric BMD, geometry, and bone strength in young girls

Osteoporosis International

Peripheral quantitative computed tomography (pQCT) to assess bone health in children, adolescents, and young adults: A review of normative data

Journal of Pediatric Hematology Oncology

Influence of a school-based physical activity intervention on cortical bone mass distribution: A 7-year intervention study

Calcified Tissue International

Jumping improves hip and lumbar spine bone mass in prepubescent children: A randomized controlled trial

Journal of Bone and Mineral Research

Physical fitness differences in children with and without motor learning difficulties

European Journal of Special Needs Education